Nose Flashcards
What is rhinusitis?
Inflammation of nose and paranasal sinuses with 2 or more of:
- Nasal blockage / obstruction
- Nasal discharge
- Facial pain / pressure
- Reduction or loss of smell
How is rhinusitis defined?
Acute
Chronic (>12wks)
What is the management of acute rhinositus (common cold)?
Self limiting
If >5 days, can give intranasal corticosteroids eg mometasone or fluticasone
What can be given in allergic rhinosinutis?
1st line NASAL ANTIHISTAMINES in flare 2nd line (mod-severe) Intranasal corticosteroid 3rd line (severe/uncontrolled): oral dose of Pred 5-20 days
What would make you consider acute bacterial sinusitis?
What is the treatment?
- Symptoms for more than 10 days
- Discoloured or purulent nasal discharge (with unilateral predominance).
- Severe local pain (with unilateral predominance).
- A fever greater than 38°C.
- A marked deterioration after an initial milder form of the illness (so-called ‘double-sickening’).
- Elevated ESR/CRP (although the practicality of this criterion is limited).
Amoxicillin
What is the treatment of acute sinusitis?
- Less than 10 days COMPLETELY SELF LIMITING
- More than 10 days: high-dose nasal corticosteroid
How long can chronic sinusitis last?
What is the managment?
-Chronic sinusitis can last months
Management
- Avoid triggers, stop smoking
- Consider a course of intranasal corticosteroids (for example, mometasone or fluticasone) for up to 3 months,
How does chronic sinusitis with nasal polyps present?
Important to test for what in kids?
Sneezing Nasal drip Nasal obstriction Sinusitis Mouth breathing Snoring Headaches **test for CF in children!!
When do nasal polyps require urgent referral for biopsy?
RED FLAGS
- Single unilateral polyp (unilateral discharge)
- Bleeding
May be intranasal pathology eg nasopharyngeal cancer or lymphoma
What is the medical management of chronic rhinosinusitis with nasal polyps?
REFER ALL PATIENTS TO ENT (full exam)
Topical steroids 2 weeks eg BETAMETHACONE 0.1% (shrink polyps)
Followed by FLUTICASONE (steroid spray) 100mcg 2 sprays / 24 hours in both nostrils for 3 months
Consider long term abx eg doxycycline
What is the surgical management of chronic rhinosinusitis with nasal polyps?
Endoscopic sinus surgery - watch out for CSF leak in recovery
Dont blow nose until you are better
How does a septal haematoma present?
Following trauma
-A boggy, bilateral cherry red swelling from septum
How is a septal haematoma managed?
Complication of septal haematoma?
Refer to ENT for urgent incision and drainage
***Damage to septal cartilage can occur within 24 hours and if it is left untreated can lead to irreversible septal perforation and necrosis - saddle-nose deformity
What is the management of a nasal fracture?
Analgesia
Ice
Close skin injury
Reassess 5-7 days post injury once swelling resolved
If manipulation under anaesthesia (MUA) required, perform day 10-14 after injury before nasal bones set
Sign of ethmoid fracture?
CSF rhinorrhoea through disrupting dura and arachnoid layers
